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A clear cell adenocarcinoma of the gallbladder with hepatoid differentiation: case report and review of literature

View Article: PubMed Central - PubMed

ABSTRACT

An 80-year-old male was referred to our department for a gallbladder mass. He denied any history of alcohol consumption or cholecystitis and smoking. Hepatitis B surface antigen test and antihepatitis C antibody test were found to be negative. Serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen were elevated (CA19-9 was 59.92 U/mL and carcinoembryonic antigen was 12.64 ng/mL), whereas alpha-fetoprotein was below the normal limit (2.46 ng/mL). Computed tomography scan revealed a solid mass with measurements of 4.6×5.6×7.1 cm, which nearly filled the whole gallbladder space. Radical cholecystectomy, including segments IV B and V of the liver and lymphadenectomy, was performed. The neoplasm in gallbladder was completely resected, and the patient obtained a negative margin. Histological and immunohistochemical profile suggested a clear cell adenocarcinoma of the gallbladder with hepatoid differentiation. After reviewing the literature, we reported that this case is the first identified case of cell adenocarcinoma of the gallbladder with extensive hepatoid differentiation. However, clinical features of clear cell adenocarcinoma with hepatoid differentiation remain unclear due to the extremely rare incidence. There was no indication of adjuvant chemotherapy and no literature has been reported on the application of chemotherapy. This case showed a promising clinical outcome after curative resection, which indicated that surgical treatment could be potentially considered for suitable patients.

No MeSH data available.


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Histology of the CCG.Notes: (A) Approximately 70% of the lesion is composed of clear cell (H&E; original magnification ×40). (B) Clear cell adenocarcinoma composed of cells with hepatoid differentiation. The tumor cells are arranged in a nested and trabecular pattern (H&E; original magnification ×100). In immunohistochemical stain: (C) in the hepatoid areas, HepPar 1 immunoreactivity shows a coarse granular staining (H&E; original magnification ×100), (D) the tumor cells are positive for CK19 (H&E; original magnification ×100), (E) the tumor cells are negative for AFP (H&E; original magnification ×100), (F) the tumor cells are positive for CK8-18 (H&E; original magnification ×100), (G) the tumor cells are positive for GPC-3 (H&E; original magnification ×100), and (H) the tumor cells are negative for SMA (H&E; original magnification ×100).Abbreviations: CCG, cell adenocarcinoma of the gallbladder; H&E, hematoxylin and eosin; HepPar 1, Hepatocyte Paraffin 1; CK, cytokeratin; AFP, alpha-fetoprotein; GPC-3, Glypican 3; SMA, smooth muscle actin.
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f3-ott-9-5797: Histology of the CCG.Notes: (A) Approximately 70% of the lesion is composed of clear cell (H&E; original magnification ×40). (B) Clear cell adenocarcinoma composed of cells with hepatoid differentiation. The tumor cells are arranged in a nested and trabecular pattern (H&E; original magnification ×100). In immunohistochemical stain: (C) in the hepatoid areas, HepPar 1 immunoreactivity shows a coarse granular staining (H&E; original magnification ×100), (D) the tumor cells are positive for CK19 (H&E; original magnification ×100), (E) the tumor cells are negative for AFP (H&E; original magnification ×100), (F) the tumor cells are positive for CK8-18 (H&E; original magnification ×100), (G) the tumor cells are positive for GPC-3 (H&E; original magnification ×100), and (H) the tumor cells are negative for SMA (H&E; original magnification ×100).Abbreviations: CCG, cell adenocarcinoma of the gallbladder; H&E, hematoxylin and eosin; HepPar 1, Hepatocyte Paraffin 1; CK, cytokeratin; AFP, alpha-fetoprotein; GPC-3, Glypican 3; SMA, smooth muscle actin.

Mentions: Microscopically, >70% of the tumor was clear cells, which had large and well-defined cytoplasm borders (Figure 2). The clear cells were characterized by plentiful clear cytoplasm and distinct cell borders. The cells have large nuclei, prominent nucleoli, and little nuclear atypia. These cells were indistinguishable from hepatocellular adenocarcinoma and arranged in nests, sheets, and trabeculae (Figure 3). Conventional adenocarcinoma with enhanced mucin production was observed in the foci. Pathological examination of the lymph nodes along the hepatic artery revealed metastasis. The other lymph nodes revealed no metastasis. Interestingly, they showed skip metastasis, which spread to the hepatic artery lymph node without involvement of the hepatoduodenal ligament along the bile duct lymph node. There was no neural invasion or vascular invasion.


A clear cell adenocarcinoma of the gallbladder with hepatoid differentiation: case report and review of literature
Histology of the CCG.Notes: (A) Approximately 70% of the lesion is composed of clear cell (H&E; original magnification ×40). (B) Clear cell adenocarcinoma composed of cells with hepatoid differentiation. The tumor cells are arranged in a nested and trabecular pattern (H&E; original magnification ×100). In immunohistochemical stain: (C) in the hepatoid areas, HepPar 1 immunoreactivity shows a coarse granular staining (H&E; original magnification ×100), (D) the tumor cells are positive for CK19 (H&E; original magnification ×100), (E) the tumor cells are negative for AFP (H&E; original magnification ×100), (F) the tumor cells are positive for CK8-18 (H&E; original magnification ×100), (G) the tumor cells are positive for GPC-3 (H&E; original magnification ×100), and (H) the tumor cells are negative for SMA (H&E; original magnification ×100).Abbreviations: CCG, cell adenocarcinoma of the gallbladder; H&E, hematoxylin and eosin; HepPar 1, Hepatocyte Paraffin 1; CK, cytokeratin; AFP, alpha-fetoprotein; GPC-3, Glypican 3; SMA, smooth muscle actin.
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f3-ott-9-5797: Histology of the CCG.Notes: (A) Approximately 70% of the lesion is composed of clear cell (H&E; original magnification ×40). (B) Clear cell adenocarcinoma composed of cells with hepatoid differentiation. The tumor cells are arranged in a nested and trabecular pattern (H&E; original magnification ×100). In immunohistochemical stain: (C) in the hepatoid areas, HepPar 1 immunoreactivity shows a coarse granular staining (H&E; original magnification ×100), (D) the tumor cells are positive for CK19 (H&E; original magnification ×100), (E) the tumor cells are negative for AFP (H&E; original magnification ×100), (F) the tumor cells are positive for CK8-18 (H&E; original magnification ×100), (G) the tumor cells are positive for GPC-3 (H&E; original magnification ×100), and (H) the tumor cells are negative for SMA (H&E; original magnification ×100).Abbreviations: CCG, cell adenocarcinoma of the gallbladder; H&E, hematoxylin and eosin; HepPar 1, Hepatocyte Paraffin 1; CK, cytokeratin; AFP, alpha-fetoprotein; GPC-3, Glypican 3; SMA, smooth muscle actin.
Mentions: Microscopically, >70% of the tumor was clear cells, which had large and well-defined cytoplasm borders (Figure 2). The clear cells were characterized by plentiful clear cytoplasm and distinct cell borders. The cells have large nuclei, prominent nucleoli, and little nuclear atypia. These cells were indistinguishable from hepatocellular adenocarcinoma and arranged in nests, sheets, and trabeculae (Figure 3). Conventional adenocarcinoma with enhanced mucin production was observed in the foci. Pathological examination of the lymph nodes along the hepatic artery revealed metastasis. The other lymph nodes revealed no metastasis. Interestingly, they showed skip metastasis, which spread to the hepatic artery lymph node without involvement of the hepatoduodenal ligament along the bile duct lymph node. There was no neural invasion or vascular invasion.

View Article: PubMed Central - PubMed

ABSTRACT

An 80-year-old male was referred to our department for a gallbladder mass. He denied any history of alcohol consumption or cholecystitis and smoking. Hepatitis B surface antigen test and antihepatitis C antibody test were found to be negative. Serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen were elevated (CA19-9 was 59.92 U/mL and carcinoembryonic antigen was 12.64 ng/mL), whereas alpha-fetoprotein was below the normal limit (2.46 ng/mL). Computed tomography scan revealed a solid mass with measurements of 4.6×5.6×7.1 cm, which nearly filled the whole gallbladder space. Radical cholecystectomy, including segments IV B and V of the liver and lymphadenectomy, was performed. The neoplasm in gallbladder was completely resected, and the patient obtained a negative margin. Histological and immunohistochemical profile suggested a clear cell adenocarcinoma of the gallbladder with hepatoid differentiation. After reviewing the literature, we reported that this case is the first identified case of cell adenocarcinoma of the gallbladder with extensive hepatoid differentiation. However, clinical features of clear cell adenocarcinoma with hepatoid differentiation remain unclear due to the extremely rare incidence. There was no indication of adjuvant chemotherapy and no literature has been reported on the application of chemotherapy. This case showed a promising clinical outcome after curative resection, which indicated that surgical treatment could be potentially considered for suitable patients.

No MeSH data available.


Related in: MedlinePlus